Neuropathic bladder (NB) is defined as a “problem in which a person lacks bladder control due to a brain, spinal cord, or nerve condition.” When NB results in incomplete bladder emptying, urinary catheters are often needed. A drawback of catheter use is that bacteria from the gastrointestinal tract and perineum more easily ascend the urethra to the bladder along the surface of the catheter, leading to the nearly universal presence of bacteria in the bladder.
Because catheter-associated urinary tract infection (UTI) is the most common healthcare-associated infection, a tremendous array of resources have been devoted to its prevention, largely centered on curtailing use of, and seeking alternatives to, indwelling urinary catheter use. While these techniques have proven to be effective, there is a large and increasing proportion of the population who require, and benefit from, urinary catheterization due to NB or other medical conditions. These individuals cannot benefit from the prevailing strategies of limiting exposure to urinary catheters.
Clinical dogma has been that “healthy” urine is sterile, and as such the presence of bacteria in the urine (i.e., bacteriuria) not due to sample contamination is considered “abnormal” and perhaps a precursor to UTI. However, it is recognized that under certain conditions, generally associated with poor bladder emptying (i.e., NB), individuals can have bacteriuria and remain asymptomatic (i.e., asymptomatic bacteriuria or ABU). In general, ABU requires no treatment. However, its clinical relevance to the individual with NB, who may not readily perceive symptoms, is poorly understood by most practitioners, leading to uncertainty of whether or not to treat ABU in this population. Further, evidence-based guidelines for UTI diagnosis in people with NB advise against consideration of cloudy, foul-smelling urine or even white blood cells found on urinalysis as indicators of infection. This differs considerably from typical clinical practice, leading to wide variations in diagnostic and prescribing patterns, with widespread overuse of antimicrobials that might disproportionately affect people with NB. Therefore, there is a critical need for novel methods of identifying and treating neuropathic bladder patients with a high risk of UTI.